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Open Access 01-12-2019 | Care | Study protocol

Pain neuroscience education and physical exercise for patients with chronic spinal pain in primary healthcare: a randomised trial protocol

Authors: Miguel A. Galán-Martín, Federico Montero-Cuadrado, Enrique Lluch-Girbes, M. Carmen Coca-López, Agustín Mayo-Iscar, Antonio Cuesta-Vargas

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

Abstract

Background

Chronic musculoskeletal pain affects more than 20% of the population, and the prevalence is increasing, causing suffering, loss of quality of life, disability, and an enormous expenditure on healthcare resources. The most common location for chronic pain is the spine. Many of the treatments used are mainly passive (pharmacological and invasive) and poor outcomes. The treatments currently applied in the public health system do not comply with the recommendations of the main clinical practice guidelines, which suggest the use of educational measures and physical exercise as the first-line treatment. A protocol based on active coping strategies is described, which will be evaluated through a clinical trial and which could facilitate the transfer of the recommendations of the clinical practice guidelines to a primary care setting.

Methods

Randomised and multicentre clinical trials, which will be carried out in 10 Primary Care centres. The trial will compare the effect of a Pain Neuroscience Education program (six sessions, 10 h) and group physical exercise (18 sessions program carried out in six weeks, 18 h), with usual care physiotherapy treatment. Group physical exercise incorporates dual tasks, gaming, and reinforcement of contents of the educational program. The aim is to assess the effect of the intervention on quality of life, as well as on pain, disability, catastrophism, kinesiophobia, central sensitisation, and drug use. The outcome variables will be measured at the beginning of the intervention, after the intervention (week 11), at six months, and a year.

Discussion

Therapeutic interventions based on active coping strategies are essential for the treatment of chronic pain and the sustainability of the Public Health System. Demonstrating whether group interventions have an effect size is essential for optimising resources in such a prevalent problem.

Trial registration

NCT03654235 “Retrospectively registered” 31 August 2018.

Available only for authorised users

Langley PC. The prevalence, correlates and treatment of pain in the European Union. Curr Med Res Opin [Internet]. 2011 Feb 11 [cited 2016 Mar 25];27(2):463–480. Available from: http://www.tandfonline.com/doi/full/10.1185/03007995.2010.542136

Breivik H, Eisenberg E, O’Brien T. The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC Public Health [Internet]. 2013;13(1):1229. Available from: http://www.biomedcentral.com/1471-2458/13/1229

GBD 2017 Disease and Injury Incidence and Prevalence Collaborators SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England) [Internet]. 2018 Nov 10 [cited 2019 Apr 12];392(10159):1789–1858. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30496104

Langley P, Müller-Schwefe G, Nicolaou A, Liedgens H, Pergolizzi J, Varrassi G. The societal impact of pain in the European Union: health-related quality of life and healthcare resource utilization. J Med Econ [Internet]. 2010 Sep 3 [cited 2016 Mar 25];13(3):571–81. Available from: http://www.tandfonline.com/doi/full/10.3111/13696998.2010.516709.PubMedCrossRef

Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain [Internet] 2012;13(8):715–724. Available from: https://doi.org/10.1016/j.jpain.2012.03.009 PubMedCrossRef

Jordan KP, Kadam UT, Hayward R, Porcheret M, Young C, Croft P. Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study. BMC Musculoskelet Disord [Internet]. 2010 Dec 2 [cited 2019 Apr 8];11(1):144. Available from: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-11-144

Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J [Internet]. 2018; Available from: http://www.ncbi.nlm.nih.gov/pubmed/29480409.

Nijs J, Meeus M, Oosterwijck J Van, Roussel N, Kooning M De, Ickmans K, et al. Treatment of central sensitization in patients with ‘ unexplained ’ chronic pain : what options do we have? Expert Opin Pharmacother [Internet]. 2011 May 22 [cited 2019 May 28];12(7):1–12. Available from: http://www.tandfonline.com/doi/full/10.1517/14656566.2011.547475

Jonas WB, Crawford C, Colloca L, Kriston L, Linde K, Moseley B, et al. Are invasive procedures effective for chronic pain? A systematic review. Pain Med [Internet]. 2018 Sep 10 [cited 2018 Dec 14]; Available from: https://academic.oup.com/painmedicine/advance-article-abstract/doi/10.1093/pm/pny154/5094687

10.

Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain [Internet]. 2011;152(SUPPL.3):S2–15. Available from: https://doi.org/10.1016/j.pain.2010.09.030 CrossRef

11.

Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895–926.PubMedPubMedCentralCrossRef

12.

Woolf CJ, Bennett GJ, Doherty M, Dubner R, Kidd B, Koltzenburg M, et al. Towards a mechanism-based classification of pain? Pain. 1998;77(3):227–9.PubMedCrossRef

13.

Nijs J, Van Houdenhove B, Oostendorp RAB. Recognition of central sensitization in patients with musculoskeletal pain: Application of pain neurophysiology in manual therapy practice. Man Ther [Internet]. 2010 Apr [cited 2016 Mar 24];15(2):135–141. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1356689X09001921

14.

Apkarian A V. Chronic back pain is associated with decreased prefrontal and thalamic gray matter Ddensity. J Neurosci [Internet]. 2004 Nov 17 [cited 2016 Mar 24];24(46):10410–10415. Available from: http://www.jneurosci.org/cgi/doi/10.1523/JNEUROSCI.2541-04.2004

15.

Wood PB. Variations in brain gray matter associated with chronic pain. Curr Rheumatol Rep [Internet]. 2010 Dec 21 [cited 2016 Mar 24];12(6):462–469. Available from: http://link.springer.com/10.1007/s11926-010-0129-7

16.

May A. Chronic pain may change the structure of the brain. Pain. 2008;137(1):7–15.PubMedCrossRef

17.

Smallwood RF, Laird AR, Ramage AE, Parkinson AL, Lewis J, Clauw DJ, et al. Critical review. structural brain anomalies and chronic pain: A quantitative meta-analysis of gray matter volume. J Pain [Internet]. 2013 [cited 2019 Jan 12];14(7):663–675. Available from: www.jpain.organdwww.sciencedirect.com PubMedPubMedCentralCrossRef

18.

Rodriguez-Raecke R, Niemeier A, Ihle K, Ruether W, May A. Brain gray matter decrease in chronic pain ss the consequence and not the cause of pain. J Neurosci [Internet]. 2009 Nov 4 [cited 2016 Mar 24];29(44):13746–13750. Available from: http://www.jneurosci.org/cgi/doi/10.1523/JNEUROSCI.3687-09.2009

19.

Daenen L, Nijs J, Roussel N, Wouters K, Van Loo M, Cras P. Dysfunctional pain inhibition in patients with chronic whiplash-associated disorders: an experimental study. Clin Rheumatol [Internet]. 2013 Jan 16 [cited 2016 Mar 24];32(1):23–31. Available from: http://link.springer.com/10.1007/s10067-012-2085-2 PubMedCrossRef

20.

Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain [Internet] 2011;152(SUPPL.3):S90–S98. Available from: https://doi.org/10.1016/j.pain.2010.10.020 PubMedCrossRef

21.

Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain [Internet]. 2008 Aug 1 [cited 2018 Dec 10];131(8):2161–2171. Available from: https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/awn154 PubMedCrossRef

22.

Salter MW. The neurobiology of central sensitization. J Musculoskelet Pain. 2002;10(1–2):23–33.CrossRef

23.

Fletcher C, Bradnam L, Barr C. The relationship between knowledge of pain neurophysiology and fear avoidance in people with chronic pain: A point in time, observational study. Physiother Theory Pract. 2016;32(4).PubMedCrossRef

24.

Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. J Behav Med [Internet]. 2007 Jan 31 [cited 2016 Mar 24];30(1):77–94. Available from: http://link.springer.com/10.1007/s10865-006-9085-0 PubMedCrossRef

25.

Cieza A, Stucki G, Weigl M, Kullmann L, Stoll T, Kamen L, et al. ICF Core Sets for chronic widespread pain. J Rehabil Med [Internet]. 2004 Aug 1 [cited 2017 Feb 19];36(0):63–68. Available from: http://journalsonline.tandf.co.uk/Index/10.1080/16501960410016046 CrossRef

26.

Nijs J, Meeus M, Cagnie B, Roussel NA, Dolphens M, Van Oosterwijck J, et al. A modern neuroscience approach to chronic spinal pain: Combining pain neuroscience education with cognition-targeted motor control training. Phys Ther [Internet]. 2014 May 1 [cited 2016 Mar 20];94(5):730–738. Available from: http://ptjournal.apta.org/cgi/doi/10.2522/ptj.20130258 PubMedCrossRef

27.

Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet [Internet]. 2018 Jun [cited 2018 Mar 26];391(10137):2368–83. Available from: http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30489-6.pdf.

28.

Wong JJ, Côté P, Sutton DA, Randhawa K, Yu H, Varatharajan S, et al. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain [Internet]. 2017 Feb 1 [cited 2018 Nov 29];21(2):201–216. Available from: http://doi.wiley.com/10.1002/ejp.931 PubMedCrossRef

29.

Stochkendahl MJ, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen MØMM, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J [Internet]. 2018;27(1):60–75 Available from: http://link.springer.com/10.1007/s00586-017-5099-2.CrossRef

30.

Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the american college of physicians. Ann Intern Med [Internet]. 2017 Apr 4 [cited 2018 Nov 29];166(7):514. Available from: http://annals.org/article.aspx?doi=10.7326/M16-2367 PubMedCrossRef

31.

Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. Fleckenstein J, editor. PLoS One [Internet]. 2017 Jun 22;12(6):e0178621. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28640822%0A https://doi.org/10.1371/journal.pone.0178621 PubMedPubMedCentralCrossRef

32.

Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil [Internet]. 2011 Dec [cited 2016 Feb 26];92(12):2041–2056. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0003999311006708 PubMedCrossRef

33.

Geneen LJ, Martin DJ, Adams N, Clarke C, Dunbar M, Jones D, et al. Effects of education to facilitate knowledge about chronic pain for adults: a systematic review with meta-analysis. Syst Rev [Internet]. 2015;4(1):132. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4591560&tool=pmcentrez&rendertype=abstract

34.

Daenen L, Varkey E, Kellmann M, Nijs J. Exercise, not to exercise, or how to exercise in patients with chronic pain? Applying science to practice. Clin J Pain [Internet]. 2015 Feb [cited 2016 mar 20];31(2):108–114. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24662498.PubMedCrossRef

35.

Geneen L, Smith B, Clarke C, Martin D, Colvin LA, Moore RA. Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews. Cochrane Database Syst Rev [Internet]. 2017;(2017 Issue 1):4. Available from: http://doi.wiley.com/10.1002/14651858.CD011279

36.

Snodgrass SJ, Heneghan NR, Tsao H, Stanwell PT, Rivett DA, Van Vliet PM. Recognising neuroplasticity in musculoskeletal rehabilitation: a basis for greater collaboration between musculoskeletal and neurological physiotherapists. Man Ther [Internet] 2014;19(6):614–617. Available from: https://doi.org/10.1016/j.math.2014.01.006 PubMedCrossRef

37.

Juul T, Søgaard K, Davis AM, Roos EM. Psychometric properties of the Neck OutcOme Score (NOOS), Neck Disability Index (NDI) and Short form-36 (SF-36) in longitudinal assessment of patients with neck pain. J Rehabil Med [Internet]. 2016;36. Available from: https://doi.org/10.1016/j.jclinepi.2016.03.015 PubMedCrossRef

38.

Rogge A-K, Röder B, Zech A, Hötting K. Exercise-induced neuroplasticity: Balance training increases cortical thickness in visual and vestibular cortical regions. Neuroimage [Internet]. 2018;179:471–479. Available from: https://linkinghub.elsevier.com/retrieve/pii/S105381191830572X PubMedCrossRef

39.

Amir S, Batouli H, Saba V, Amir S. At least eighty percent of brain grey matter is modifiable by physical activity: a review study medical imaging view project electromagnetic waves view project at least eighty percent of brain grey matter is modifiable by physical activity: a review study. Behav Brain Res. 2017;332:204–17.CrossRef

40.

Ray CA, Carter JR. Central modulation of exercise-induced muscle pain in humans. J Physiol [Internet]. 2007 Nov 15 [cited 2016 Mar 25];585(1):287–294. Available from: http://doi.wiley.com/10.1113/jphysiol.2007.140509 PubMedPubMedCentralCrossRef

41.

Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature. Physiother theory Pract [Internet]. 2016;3985(September):1–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27351541.

42.

Malfliet A, Kregel J, Coppieters I, Pauw R De, Meeus M, Roussel N, et al. Effect of pain neuroscience education combined with cognition-targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial. JAMA Neurol [Internet]. 2018; Available from: http://archneur.jamanetwork.com/article.aspx?doi=10.1001/jamaneurol.2018.0492

43.

Marques ES, Meziat Filho NA de M, Ferreira P dos S, Andrade FG de, Ramsay EM, Amaral Corrêa L, et al. Group pain neuroscience education combined with supervised exercises reduces pain and improves function of Brazilian women with central sensitisation and a low level of education: a single-subject study. Eur J Physiother [Internet]. 2019;21(4):224–32. Available from: https://www.tandfonline.com/doi/abs/10.1080/21679169.2018.1531922?journalCode=iejp20&.

44.

Edwards RR, Sullivan MD, Wasan AD. The role of psychosocial processes in the development and maintenance of chronic pain. J Pain [Internet]. 2016 Sep 1 [cited 2018 Dec 12];17(9):T70–T92. Available from: https://www.sciencedirect.com/science/article/pii/S1526590016000183 PubMedPubMedCentralCrossRef

45.

Burke SM, Carron A V, Eys MA, Ntoumanis N, Estabrooks PA. Group versus individual approach? A meta-analysis of the effectiveness of interventions to promote physical activity. Sport Exerc Psychol Rev [Internet]. 2006 [cited 2018 Dec 17];2:1–13. Available from: http://eprints.bham.ac.uk/426/

46.

Yorks DM, Frothingham CA, Schuenke MD. Effects of group fitness classes on stress and quality of life of medical students. J Am Osteopath Assoc [Internet]. 2017 Nov 1 [cited 2018 Dec 17];117(11):e17. Available from: http://jaoa.org/article.aspx?doi=10.7556/jaoa.2017.140

47.

Jakobsen MD, Sundstrup E, Brandt M, Jay K, Aagaard P, Andersen LL. Effect of workplace- versus home-based physical exercise on musculoskeletal pain among healthcare workers: a cluster randomized controlled trial. Scand J Work Environ Health [Internet]. 2015 Mar [cited 2018 Dec 17];41(2):153–163. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25596848.CrossRef

48.

Chan A-W, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med [Internet]. 2013 Feb 5 [cited 2019 mar 29];158(3):200–207. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23295957.PubMedPubMedCentralCrossRef

49.

Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol [Internet]. 2010 Aug 1 [cited 2019 mar 29];63(8):e1–37. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20346624.

50.

Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res [Internet]. 1975 Nov 1 [cited 2019 Mar 29];12(3):189–198. Available from: https://www.sciencedirect.com/science/article/pii/0022395675900266?via%3Dihub

51.

Llamas Velasco S, Llorente Ayuso L, Contador I, Bermejo Pareja F. Versiones en español del Minimental State Examination (MMSE). Cuestiones para su uso en la práctica clínica. Rev Neurol [Internet]. 2015 [cited 2019 Mar 29];61(08):363. Available from: https://www.neurologia.com/articulo/2015107 PubMedCrossRef

52.

Prochaska JO, DiClemente CC. Transtheoretical therapy: Toward a more integrative model of change. Psychother Theory, Res Pract [Internet]. 1982 [cited 2018 Dec 9];19(3):276–288. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/h0088437

53.

Prochaska JO. Decision making in the transtheoretical model of behavior change. Med Decis Mak [Internet]. 2008 [cited 2018 Dec 9];28:845–849. Available from: https://sagepub.publicaciones.saludcastillayleon.es/doi/pdf/10.1177/0272989X08327068

54.

Nijs J, Kosek E, Oosterwijck J Van, Meeus M, Van Oosterwijck J, Meeus M. Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise? Pain Physician [Internet]. 2012 [cited 2018 Dec 8];15(3 Suppl):205–14. Available from: http://www.painphysicianjournal.com.

55.

Smith BE, Hendrick P, Bateman M, Holden S, Littlewood C, Smith TO, et al. Musculoskeletal pain and exercise— challenging existing paradigms and introducing new. Br J Sport Med Mon 2018;(0).

56.

Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med [Internet]. 2017 Dec 1 [cited 2018 Dec 12];51(23):1679–1687. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28596288.PubMedPubMedCentralCrossRef

57.

Thompson PD, Arena R, Riebe D, Pescatello LS, American College of Sports Medicine. ACSM’s New preparticipation health screening recommendations from ACSM’s guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep [Internet]. 2013 [cited 2018 Dec 28];12(4):215–217. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23851406.PubMedCrossRef

58.

Dirección General de Asistencia Sanitaria. Protocolos de Fisioterapia en Atención Primaria [Internet]. Valladolid; 2005. Available from: http://www.saludcastillayleon.es/institucion/es/publicaciones-consejeria/buscador/protocolos-fisioterapia-atencion-primaria

59.

SERMEF (Sociedad Española de Medicina Física y Rehabilitación). WEB EJERCICIOS SERMEF – SERMEF [Internet]. [cited 2019 Apr 6]. Available from: https://www.sermef.es/web-ejercicios-sermef/

60.

Melzack R. The short-form McGill pain questionnaire. Pain. 1987 Aug;30(2):191–7.PubMedCrossRef

61.

Vilagut G, Valderas JM, Ferrer M, Garin O, López-García E, Alonso J. Interpretación de los cuestionarios de salud SF-36 y SF-12 en España: componentes físico y mental. Med Clin (Barc) [Internet]. 2008 [cited 2018 Jul 6];130(19):726–735. Available from: http://public-files.prbb.org/publicacions/e92966f0-cead-012b-a7a8-000c293b26d5.pdf

62.

Alonso J, Regidor E, Barrio G, Prieto L, Rodríguez C, De la Fuente L. Valores poblacionales de referencia de la versión española del Cuestionario de Salud SF-36. Med Clin (Barc). 1998;111(11):410–6.

63.

Chapman CR, Casey KL, Dubner R, Foley KM, Gracely RH, Reading AE. Pain measurement: an overview. Pain. 1985;22(1):1–31.PubMedCrossRef

64.

Neziri AY, Scaramozzino P, Andersen OK, Dickenson AH, Arendt-Nielsen L, Curatolo M. Reference values of mechanical and thermal pain tests in a pain-free population. Eur J Pain [Internet] 2011;15(4):376–383. Available from: https://doi.org/10.1016/j.ejpain.2010.08.011 CrossRef

65.

Fischer AA. Algometry in diagnosis of musculoskeletal pain and evaluation of treatment outcome: An update. J Musculoskelet Pain [Internet]. 1998 Jan 16 [cited 2017 Feb 3];6(1):5–32. Available from: http://www.tandfonline.com/doi/full/10.1300/J094v06n01_02

66.

Balaguier R, Madeleine P, Vuillerme N. Is one trial sufficient to obtain excellent pressure pain threshold reliability in the low back of asymptomatic individuals? A test-retest study. PLoS One [Internet]. 2016;11(8):1–16 Available from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0160866.

67.

Escobar JCZ, Del Pozo MG, Propin MG. Modificaciones del umbral de dolor en un punto gatillo miofascial tras técnica de energía muscular. Rev la Soc Esp del Dolor. 2010;17(7):313–9.CrossRef

68.

Park G, Kim CW, Park SB, Kim MJ, Jang SH. Reliability and usefulness of the pressure pain threshold measurement in patients with myofascial pain. Ann Rehabil Med [Internet]. 2011;35(3):412–7 Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3309218&tool=pmcentrez&rendertype=abstract.CrossRef

69.

García Campayo J, Rodero B, Alda M, Sobradiel N, Montero J, Moreno S. Validación de la versión española de la escala de la catastrofización ante el dolor (Pain Catastrophizing Scale) en la fibromialgia. Med Clin. 2008;131(13):487–92.CrossRef

70.

Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychol Assess [Internet]. 1995 [cited 2019 Apr 6];7(4):524–532. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/1040-3590.7.4.524

71.

Gómez-Pérez L, López-Martínez AE, Ruiz-Párraga GT. Psychometric properties of the spanish version of the Tampa scale for Kinesiophobia (TSK). J Pain. 2011;12(4):425–35.PubMedCrossRef

72.

Cuesta-Vargas AI, Roldan-Jimenez C, Neblett R, Gatchel RJ. Cross-cultural adaptation and validity of the Spanish central sensitization inventory. Springerplus [Internet]. 2016 Dec 21 [cited 2016 Oct 22];5(1):1837. Available from: http://springerplus.springeropen.com/articles/10.1186/s40064-016-3515-4

73.

Scerbo T, Colasurdo J, Dunn S, Unger J, Nijs J, Cook C. Measurement properties of the central sensitization inventory: A systematic review. Pain Pract [Internet]. 2018 Apr 1 [cited 2019 Apr 6];18(4):544–554. Available from: http://doi.wiley.com/10.1111/papr.12636

74.

Kovacs FM, Llobera J, del Real MTG, Abraira V, Gestoso M, Fernández C. Validation of the Spanish version of the Roland–Morris questionnaire. Spine (Phila Pa 1976). 2002;27(5):538–42.CrossRef

75.

Roberts RE, Atrkisson CC, Mendias RM. Assessing the client satisfaction questionnaire in English and Spanish. Hisp J Behav Sci [Internet]. 1984 Dec 25 [cited 2019 Apr 6];6(4):385–396. Available from: http://journals.sagepub.com/doi/10.1177/07399863840064004

76.

Galán-Martín M, Montero-Cuadrado F. Educación en neurociencia del dolor. Una nueva visión. dossier para pacientes. First edit. Junta de Castilla y León, editor. Junta de Castilla y León: Valladolid; 2018. 92 p.

77.

Howick J, Moscrop A, Mebius A, Fanshawe TR, Lewith G, Bishop FL, et al. Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. J R Soc Med [Internet]. 2018 Jul 19 [cited 2019 Apr 15];111(7):240–252. Available from: http://journals.sagepub.com/doi/10.1177/0141076818769477 PubMedPubMedCentralCrossRef

78.

Goicoechea A, Echávarri R. Migraña : una pesadilla cerebral [Internet]. Desclée de Brouwer; 2009 [cited 2017 Jul 8]. 342 p. Available from: https://www.edesclee.com/tematicas/psicologia/migrana-una-pesadilla-cerebral-detail

79.

Butler D, Moseley L. Explain pain. 2nd ed. Adelaide: NOI group Publications; 2013. p. 133.

80.

Louw A , Puentedura E. Therapeutic neuroscience education : teaching patients about pain : a guide for clinicians. Louisville: International Spine and Pain Institute; 2013. p. 292.

81.

Nijs J, Lluch Girbés E, Lundberg M, Malfliet A, Sterling M. Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories. Man Ther [Internet]. 2015 Feb 1 [cited 2017 Nov 27];20(1):216–220. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25090974.

82.

Booth J, Moseley GL, Schiltenwolf M, Cashin A, Davies M, Hübscher M. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care [Internet]. 2017 Dec 1 [cited 2017 Dec 16];15(4):413–421. Available from: http://doi.wiley.com/10.1002/msc.1191

83.

Cohen S, Janicki-Deverts D, Turner RB, Doyle WJ. Does hugging provide stress-buffering social support? A study of susceptibility to upper respiratory infection and illness. Psychol Sci [Internet]. 2015 Feb [cited 2018 Dec 17];26(2):135–147. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25526910.

Title: Pain neuroscience education and physical exercise for patients with chronic spinal pain in primary healthcare: a randomised trial protocol
Authors: Miguel A. Galán-Martín
Federico Montero-Cuadrado
Enrique Lluch-Girbes
M. Carmen Coca-López
Agustín Mayo-Iscar
Antonio Cuesta-Vargas
Publication date: 01-12-2019
Publisher: BioMed Central
Keyword: Care
Published in: BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-019-2889-1

At a glance: The STEP trials

Springer Medicine

Pain neuroscience education and physical exercise for patients with chronic spinal pain in primary healthcare: a randomised trial protocol

Abstract

Background

Methods

Discussion

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Discussion

Trial registration

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